Provider Demographics
NPI:1215209309
Name:TYREE, LARRY ALLEN (MD)
Entity Type:Individual
Prefix:
First Name:LARRY
Middle Name:ALLEN
Last Name:TYREE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2805 TOWNGATE DRIVE
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27614-8920
Mailing Address - Country:US
Mailing Address - Phone:919-570-3306
Mailing Address - Fax:919-570-3307
Practice Address - Street 1:2805 TOWNGATE DRIVE
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27614-8920
Practice Address - Country:US
Practice Address - Phone:919-570-3306
Practice Address - Fax:919-570-3307
Is Sole Proprietor?:No
Enumeration Date:2012-02-03
Last Update Date:2012-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC13574207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine